1. Running Head: ASPERGER’S SYNDROME 1
A Review of Problems in
the Misdiagnosis of Asperger’s Syndrome
By
Tamara Smith
Capstone Project Submitted in Partial Fulfillment
of the Requirements for the Degree of
Master of Science
Psychology
Walden University
February 20, 2011

2. ASPERGER’S SYNDROME 2
Asperger’s Syndrome
Introduction
Asperger’s Syndrome is a disorder that is fairly new to science and research. Due to the
similarities with Autism, Asperger’s Syndrome has often been misdiagnosed, and ultimately
overlooked. Asperger’s Syndrome (AS) is a developmental disorder often categorized into
Pervasive Developmental Disorders (PDD), and is sometimes referred to as autism spectrum
disorders (ASD) (Gaus, 2011). Many times this disorder is mistaken for full blown autism, but
there are some differences that set it apart from Autism. AS can be interpreted to be a disorder
where although people accommodate the requirements individuals meet the criteria for autistic
behavior, they lack a background in regard to cognition and communication (Kanai et al., 2010).
Since AS is fairly new to the scene, continued research is conducted, along with
experiments and tests to determine the overall effects of the disorder. According to Gaus (2011),
Asperger Syndrome received its first recognition in the United States in 1994 through a
publication of DSM-IV for the American Psychological Association. Since Asperger Syndrome
is considered a subtype of Autism, it’s likely that the disorder was present long before 1994.
Problem Statement
The main problem faced with this disorder is the lack of research available specifically
designed for AS and not including so much of Autism. The differences between the two
disorders should be addressed more thoroughly in research studies, which is the main problem.
Along with differentiating between the disorders and their subgroups, it’s important to diagnose
and treat the disorders properly. According to Worth & Reynolds (2008), three difficulties
associated with autistic spectrum disorder ASD can be defined in the following domains:

3. ASPERGER’S SYNDROME 3
impairments of social interaction and relationships; impairments of language and
communication; impairments of thought and imagination.
In order to diagnose AS according to DSM standards, a decrease in clinical
communication and cognition must be present, along with the inclusion of the advancement in
an individual being able to sufficiently assist themselves (Freeman et al., 2002). Without proper
diagnosis, AS will continue to be tossed under PDD and/or Autistic disorders (AD). To continue
to have this categorization, there will never be a full, distinct differentiation among the disorders.
By placing a disorder in a category or dimension, it could become less important, while there
needs to be a barrier set among the normal and abnormal, and also considering that it will be
other choices at hand (Bölte et al., 2011).
It’s been debated whether ASD should be categorical or dimensional, thus making it
important that research and clinical purposes are cautiously evaluated by the clinical validity of
diagnostic instruments making claims appropriately assessing autism as a trait (Bölte et al.,
2011). Determining how to diagnose the disorder and all its realms can be quite cumbersome. In
order to properly diagnose, researchers must carefully distinguish between each characteristic
specific to each subcategory of ASD and label accordingly. The DSM-IV states that the criteria
for AS is the same as those with AD in that there’s impairment in social interaction and
restricted, repetitive, and stereotypic patterns of interest, but to make a proper diagnosis, there
has to be a lack of any clinically significant delays in language and cognitive development
(Freeman et al., 2002).
Diagnosing AS is especially difficult in adults, but overall, the population prevalence is
fairly high (0.7%), so in clinical settings, an exact diagnosis is crucial (Kanai et al., 2010).
Within the population, researchers have studied the prevalence in boys over girls, and children

4. ASPERGER’S SYNDROME 4
versus adults. AS with other ASD’s, children with AS are much similar in that they have
difficulty with social communication and persistent idiosyncratic interests (Neihart, 2000). The
difference between children and adults with ASD, may simply be developmental. Although AS
adults have a tendency to remain socially isolated, egocentric, and idiosyncratic, they usually
become well adapted and successful (Neihart, 2000).
Integrated Literature
Autism, Asperger’s syndrome, and atypical autism/PDDNOS are generally defined by
compositions of impairments that include three domains: reciprocal social interaction, mutual
verbal and nonverbal communication alongside with inflexible behavior patterns, interests and
activities (Bölte et al., 2010). Although there has been an increase in the diagnosis under the
label of autism spectrum disorders (ASD), a significant amount of research concludes there are
difficulties in differentiation, and most likely form one clinical spectrum of behavior problems
(Bölte et al., 2010).
Asperger’s Syndrome (AS) is often categorized as a Pervasive Developmental Disorder
(PDD) within the autistic spectrum. Although there are some differences among PDD, AS is
more often confused with Autism. AS can be interpreted as a disorder where although each
person upholds the requirements for Autistic behavior, they lack the background exhibiting
cognition or lags in communications (Kanai et al., 2010). It’s been debatable whether to provide
AS with its own category within the DSM-IV. There is a lingering confusion that continues as to
whether AS is indeed a distinct diagnostic category, different from autistic disorder (AD), or lies
in a scope of social communication learning disability with AD (Freeman et al., 2002).
In order to diagnose AS according to DSM standards, there has to be insufficient
language and cognitive delays, which include age-appropriate self-help skills (Freeman et al.,

5. ASPERGER’S SYNDROME 5
2002). Without proper diagnosis, AS will continue to be tossed under PDD and/or Autistic
disorders (AD). To continue to have this categorization, there will never be a full, distinct
differentiation among the disorders. By establishing a disorder as either categorical or
dimensional may come across as less significant, but in either case, a boundary can be made
between the normal and abnormal to determine whether an individual needs assistance or not
(Bölte et al., 2011).
Individuals with PDD share certain neuropsychological characteristics much the same as
those suffering from autism, however, they do not uphold the formal criteria for autism, and
Asperger’s Syndrome is one of those disorders (Neihart, 2000). This in itself makes it difficult
to differentiate AS from other PDD, which can also make it hard to accurately diagnose the
proper disorder. When diagnosing AD, AS must be withdrawn to meet the criteria for DSM-IV,
which in turn may lead to one of a few problems which make diagnosis quite challenging for
those with AS according to the DSM-IV (Freeman et al., 2002).
Critical Analysis Narrative
There is a dearth of knowledge on Autism and Pervasive Developmental Disorders, but
there continues to be a gap in the literature. Much of the literature suggests that all PDD are
clumped together because they share many commonalities. The symptoms are classic for each,
but there are a limited number of specific differences. Although, literature acknowledges that
there are differences, Asperger’s Syndrome in particular is often overlooked. The analysis of
PDD not otherwise noted is considered when there are deficiencies in social reciprocity and the
ability to communicate lacks severity, which cannot permit enough a diagnosis of AD or AS
(Solomon et al., 2007).

6. ASPERGER’S SYNDROME 6
The major cause for the gaps and the disorder being overlooked is that the symptoms are
remotely the same for each subcategory of Autism. In 1994, a DSM-IV field trial concluded a
significant amount of knowledge which can consider Asperger’s Syndrome to be part of
Pervasive Developmental Disorders, but there still remained quite a few difficulties for
researchers (Freeman et al., 2002). Previously, researchers have used well-known questionnaires
to determine differences with PDD, such as the Autism-Spectrum Quotient (AQ), Krug
Asperger’s Disorder Index (KADI), and Gilliam Asperger’s Disorder Scale (GADS). Two other
types of tests, which may be included due to similarities in disorders, are the Schizotypal
Personality Questionnaire (SPQ) and the Eysenck Personality Questionnaire (EPQ). The SPQ is
often used due to AS and SPD (schizotypal personality disorder) having significant similarities,
while the EPQ may be used to assess neuroticism, psychoticism, and extraversion (Kanai et al.,
2011).
Another gap that requires consideration is AS and gifted children. There are a number of
similarities between the two, such as verbal fluency, excellent memory skills, letters and
numbers fascinations, and hypersensitivity (Neihart, 2000). Many AS patients demonstrate
many of the same characteristics of those considered gifted. This can pose an overall dilemma
when trying to diagnose a patient. Among all the major similarities, the lack of insight and
awareness in response to the feelings, needs, and interests of others is the most distinguishing
(Neihart, 2000).
The effects of diagnosing or even recognizing Asperger’s Syndrome can be quite a
challenge. Considering that there are more similarities than differences, coming to a conclusive
diagnosis can require extensive research and implementation of new studies and tests. It can be
quite a task deciding whether the unusual development of a child is indeed a result of being

7. ASPERGER’S SYNDROME 7
gifted, a learning disability, or AS, most especially with highly gifted children (Neihart, 2000).
Often, research suggests that individuals with AS usually do not experience difficulties in their
use of language and understanding, but it has been suggested that researchers and parents pay
more attention to this misconception (Worth & Reynolds, 2008).
Another effect in regard to AS is the amount and type of testing involved providing an
accurate diagnosis. It is quite important for researchers and clinicians to be careful when
analyzing scientific validations in regard to tools used to diagnose that can demand the rights to
Autistic diagnosis (Bölte et al., 2011). Alternating or even administering all tests known to
diagnose PDD will serve quite beneficial. It is important to consider other closely related
disorders and their testing procedures, which can also be used to test PDD positively. Since AS it
usually diagnosed in children, it is extremely difficult to determine prevalence rates with adults,
but since we know that AS is lifelong disorder, it is likely that rehabilitation professionals will
encounter growing numbers of adolescents and adults suffering from the disorder who are in
need of support and assistance (Higgins et al., 2008).
Having the triad of impairments can assist therapists and clinicians in properly
diagnosing individuals suspected to have AS or PDD. Adding a possible fourth impairment may
stunt or become troublesome towards any future diagnosis with the disorder. The effects of this
triad as presented by Attwood (1998), as cited by Worth & Reynolds (2008), redefines the
diagnosis of AS a subgroup within the autistic spectrum including its own diagnostic criteria,
while further evidence also suggests that it is more common than classic autism and can be
diagnosed in children who have not previously been diagnosed autistic.

8. ASPERGER’S SYNDROME 8
Lastly, the effects of testing and criteria requirements can differ for each clinician and
therapists, which can be cause for concern in proper diagnosis. It is noted by Wittmann (1998) as
cited by Worth & Reynolds (2008) that to analyze children’s performance on standardized tests,
it is highly recommended that additional evidence should be gained from the child’s
environment, and linguistic and communicative competence when completing a profile of
strengths and needs of all children. Since the prevalence of the AS population is high (0.7%), an
exact diagnosis is important in the clinical setting, especially for those considered to be adults
(Kanai et al., 2011). When diagnosing AS, it is critical to take all necessary measures and steps
in the proper testing to achieve proper and accurate results. Kanai et al., (2011) suggests that in
diagnosing AS, it may be beneficial to include traits of Schizotypal Personality Disorder (SPD)
due to the report by Gaus (2007), which indicates that AS and SPD have three common traits
which include: odd beliefs and mannerisms, few or no friendships, and social anxiety.
Problem Resolution
Although symptoms are similar among those diagnosed within the Autism spectrum, it’s
important to differentiate any little trait which may be key to AS. Several types of testing are
done, but critically analyzing each symptom for each PDD will lead to a more conclusive
outcome. Often, research proposes that people with Asperger’s Syndrome usually never
encounter any problems with the use of language and understanding, but it has been suggested
that researchers and parents pay more attention to this misconception (Worth & Reynolds, 2008).
Administering random tests where those who experience difficulty with the use of language and
understanding, versus those who do not. Applying the results of this test along with a comparison
of all other known testing procedures should aid researchers in determining better conclusions.
The advantages could show new progress in the diagnosis of AS, while the disadvantage could

9. ASPERGER’S SYNDROME 9
be there is no change. Also the lack of considering the use of language and understanding in
itself could be all the diagnosis necessary.
Freitag, (2007), as cited by Rao & Salmon, (2010) found that 90% of differences with
autistic and non-autistic individuals is thought to be a result of genetic effects, upon a study
conducted on British twins. This key evidence can provide great insight to any future diagnosis
of ASD. Researchers and other health care professionals can link genetics to the overall cause
and outcome of ASD. Many times ASD can be difficult to detect and diagnose during the early
stages of an individual’s life. Several tests can be conducted in an attempt to determine the
causes of a child’s behavior, or lack thereof. Such tests include: the Modified Checklist for
Autism in Toddlers (M-CHAT), the Early Screening of Autistic Traits Questionnaire, and the
First Year Inventory (Rao & Salmon, 2010). Along with these questionnaires, there is a host of
disorder specific diagnostic instruments that can be used in diagnosis. Rao & Salmon (2010) note
that Autism Diagnostic Interview-Revised (ADI-R), the Diagnostic Interview for Social and
Communication Disorders (DISCO), and the Developmental, Dimensional and Diagnostic
interview (3Di) can be implemented while also monitoring a child’s behavior in various daily
settings.
These tests and instruments can prove beneficial as they will all detect different aspects
and factors which can be used to accurately diagnose an individual who potentially poses
characteristics specific to ASD. The advantages of such testing can simply determine whether an
individual suffers from ASD. The dilemma arises when it’s time to narrow a diagnosis down to
a particular subcategory or underlying disorder within the ASD framework. Although this can be
tedious and cumbersome, such testing may provide links to those subcategories, such as

10. ASPERGER’S SYNDROME 10
Asperger’s Syndrome, which falls under ASD. The outcomes of each test administered may
potentially show more evidence towards one spectrum over another.
The potential disadvantage of these testing procedures is that results can stagnate any
progress in this area. Testing results can continuously show that a child suffers from ASD alone
without detecting any further underlying disorders. Francis (2005) as cited by Rao & Salmon
(2010) suggest that for ASD, various interventions and treatments are available, but the evidence
base can be stronger for some compared to others. When determining the diagnosis of an
individual suspected to have ASD, it’s important to consider other closely related disorders. A
disadvantage in doing this can be that considering other disorders could cloud the overall
judgment of a therapist, further hindering accurate diagnosis. For therapists it’s critical that they
are aware and properly trained in detecting features of ASD which can later be beneficial in
pinpointing the nature and severity of the issue (Rao & Salmon, 2010).
Conclusions
In conclusion there are factors that can determine differences within the spectrum of
disorders, but can often be misconstrued or even overlooked. According to Worth & Reynolds
(2008), there are three challenges with ASD, which can be explained in the following domains:
impairments of social interaction and relationships; impairments of language and
communication; impairments of thought and imagination. Although domains may be set, issues
may still arise during diagnosis and overall treatment. Many studies show a large amount of
contradiction in symptomatology, mainly in the heart of social deficits, but comparisons between
AS and AD are displayed in early child development, most especially in relation to language and
cognitive abilities, comorbid symptoms and conditions, and adaptive functioning (Freeman et al.,
2002).

11. ASPERGER’S SYNDROME 11
AS is one of five PDD also known as Autism Spectrum Disorder (ASD), which generally
affects an individual’s intellectual functioning (Higgins et al., 2008). This disorder can be found
or misdiagnosed with individuals who are considered gifted. Also, it’s important to include other
disorders which may affect or be in combination with AS or PDD such as Schizophrenia.
Estimates on the prevalence of AS can be difficult to acquire due to the rates of other ASDs, and
researchers apply different diagnostic criteria in determining diagnosis (Higgins et al., 2008).
According to Solomon et al., (2007), despite various empirical psychosocial arbitrations in
regard to kids who maintain less active patterns of Autism, no random or monitored attempts of
psychosocial arbitrations towards a more high level of function have been noted among more
aged persons.
The effects of adding or finding new traits and characteristics into the ASD may prove to
be useful and beneficial in any future diagnosis and treatment. Over time, the diagnoses are
increasing clinically as specified under the label of ASD (Bölte et al., 2011). Even if findings
depict there are only three domains instead of the possible four, more thorough testing should be
administered and completed. By using psychometric tools designed for the general population,
there can possible be a shift from psychiatry and clinical psychology to differential and personal
psychology, in turn, providing great significance for research and clinical use to cautiously
evaluate the clinical validity of diagnostic instruments which claim to be appropriate in assessing
autism as a trait (Bölte et al., 2011).
Reactions to the project

12. ASPERGER’S SYNDROME 12
The main focus of this paper was to pinpoint any issues or discrepancies with the
diagnosing of Asperger’s Syndrome. Often times this disorder goes misdiagnosed, overlooked,
and essentially dismissed. In completing this assignment, I have come across a tremendous
amount of useful and insightful information that could be contributed to future research and
proper diagnosis of AS. The scope of this disorder can be quite broad, with several different
disorders clumped within the Autism spectrum.
I highly enjoyed and appreciated the use of weekly application assignments composing
bits and pieces of our final paper. This method made the process of composing my final paper
much smoother and easier. The assistance and guidance provided by Dr. Friedman was also of
great help, and I would highly recommend her to anyone taking the Capstone course. Breaking
down each section of the paper weekly allowed for revisions, and the addition of extra
information.
Overall, the section I enjoyed composing most was the critical analysis narrative. This
section allowed me to integrate my findings into one area, while pointing out the specifics on
what the major problem at hand is and pointing out any gaps in literature. I knew that Autism in
itself was a major issue that deserved much more attention than it receives, but I did not know
that there were so many aspects to the disorder overall. It was very interesting to learn such
aspects, contributing factors, causes, and additional information. I am glad that I chose to take
this course, which allowed me to gain more knowledge on a topic of great interest.
References

13. ASPERGER’S SYNDROME 13
Bölte, S., Westerwald, E., Holtmann, M., Freitag, C., & Poustka, F.. (2011). Autistic Traits and
Autism Spectrum Disorders: The Clinical Validity of Two Measures Presuming a
Continuum of Social Communication Skills. Journal of Autism and Developmental
Disorders, 41(1), 66-72. Retrieved from
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2015&FMT=7&DID=2218234051&RQT=309
Freeman, B., Cronin, P., & Candela, P. (2002). Aspergers Syndrome or Autistic Disorder? The
Diagnostic Dilemma. Focus on Autism and Other Developmental Disabilities, 17(3),
145-151. doi: 10.1177/10883576020170030401
Gaus, V.. (2011). Adult Asperger Syndrome and the Utility of Cognitive-Behavioral
Therapy. Journal of Contemporary Psychotherapy, 41(1), 47-56. Retrieved from
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2015&FMT=7&DID=2224811261&RQT=309&cfc=1
Higgins, K. K., Kocha, L. C., Boughfman, E. M., & Vierstra, C. (2008). School-to-work
transition and Asperger Syndrome. Work, 31(3), 291-298. Retrieved from
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characteristics of adults with Asperger’s Syndrome assessed with self-report

14. ASPERGER’S SYNDROME 14
questionnaires. Research in Autism Spectrum Disorders, 5(1), 185-190.
doi:10.1016/j.rasd.2010.03.008
Neihart, M. (2000). Gifted Children With Asperger's Syndrome. Gifted child quarterly, 44(4),
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Rao, S., & Salmon, G. (2010). Autism spectrum disorders. British Journal Of Hospital Medicine
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WCIT
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